Elsevier

The Annals of Thoracic Surgery

Volume 96, Issue 6, December 2013, Pages 1919-1926
The Annals of Thoracic Surgery

Original article
General thoracic
Predictors of Anastomotic Leak After Esophagectomy: An Analysis of The Society of Thoracic Surgeons General Thoracic Database

Presented at the Forty-ninth Annual Meeting of The Society of Thoracic Surgeons, Los Angeles, CA, Jan 26–30, 2013.
https://doi.org/10.1016/j.athoracsur.2013.07.119Get rights and content

Background

Anastomotic leak is an important cause of morbidity and mortality after esophagectomy. Few studies have targeted risk factors for the development of leak after esophagectomy. The purpose of this study is to use The Society of Thoracic Surgeons Database to identify variables associated with leak after esophagectomy.

Methods

The Society of Thoracic Surgeons Database was queried for patients treated with esophagectomy for esophageal cancer between 2001 and 2011. Univariate and multivariate analysis of variables associated with an increased risk anastomotic leak was performed.

Results

There were 7,595 esophagectomies, with 804 (10.6%) leaks. Thirty-day mortality and length of stay were higher for patients with anastomotic leak. Mortality in patients requiring surgical management was 11.6% (38 of 327) compared with 4.4% (20 of 458) in medically managed leaks (p < 0.001). The leak rate was higher in patients with cervical anastomosis compared with those with intrathoracic anastomoses, 12.3% versus 9.3%, respectively (p = 0.006). There was no difference in leak-associated mortality between the two approaches. Factors associated with leak on univariate analysis include obesity, heart failure, coronary disease, vascular disease, hypertension, steroids, diabetes, renal insufficiency, tobacco use, procedure duration greater than 5 hours, and type of procedure (p < 0.05). Multivariable regression analysis associated heart failure, hypertension, renal insufficiency, and type of procedure as risk factors for the development of leak (p < 0.05).

Conclusions

Anastomotic leak after esophagectomy is an important cause of postoperative mortality and increased length of stay. We have identified important risk factors for the development of esophageal anastomotic leak after esophagectomy. Further studies aimed at risk reduction are warranted.

Section snippets

The Society of Thoracic Surgeons Database

The STS General Thoracic Surgery Database was established in 1999 to support ongoing quality and patient safety initiatives for individual surgeons and hospitals. Details of STS data collection, reporting, and auditing have been published elsewhere 9, 10. Two versions, 2.07 and 2.081, of the STS General Thoracic Data collection form have been used for this manuscript. Version 2.07 does not differentiate between types of esophageal resection (ie, transhiatal versus Ivor Lewis), whereas version

Results

There were a total of 7,595 esophageal resections entered into the STS General Thoracic Database, with a total of 804 (10.6%) anastomotic leaks. Preoperative patient variables and the univariate association with anastomotic leak are seen in Table 1. The majority of patients were white men with a median age of 63 years. Preoperative chemotherapy was administered in 50% of patients, and preoperative radiation therapy was performed in 45%. Body mass index, congestive heart failure, coronary

Comment

As the incidence of esophageal cancer continues to rise in the United States, the opportunity to perform potentially curative surgical resection also increases [12]. Esophagectomy continues to remain a challenging and difficult surgical procedure, associated with significant morbidity and mortality 13, 14. Identifying factors preoperatively in patients at risk for esophageal leak may provide opportunities to modify these factors or more fully optimize patients to reduce their risk of

References (22)

Cited by (398)

  • Incident Atrial Fibrillation and Survival Outcomes in Esophageal Cancer following Radiotherapy

    2024, International Journal of Radiation Oncology Biology Physics
View all citing articles on Scopus
View full text